Accutane For Acne: 7 Common Arguments Destroyed

Unlike oral antibiotics, the famous “last chance saloon” acne drug accutane hasn’t gone down the dumper at all recently.

If anything, accutane (isotretinoin) has clawed back its popularity over the last decade, as its famous side effects are dismissed as scare stories. From 2006 to 2016, isotretinoin prescriptions in the UK rose six-fold, from 6522 to 48997.

Dermatologists are making a pushback, claiming that acne is making people seriously depressed and accutane is the only way. They argue that they’ve “mastered” the drug and that its loss would be a tragedy on the scale of Macbeth.

If you browse acne forums and blogs, you’ll never know what to believe. There’s so many contradictory stories coming from all directions that you’ll be sucked into a vortex of confusion. For every smiling before and after photo, there’s a regretful person pleading with you to walk away.

The fact is that here, our stance on accutane hasn’t changed one bit. Most people will clear their acne with only mild side effects like dry lips (which affect 92% of users); that much is true. But accutane is also notorious for irritable bowel syndrome, depression, raising cholesterol and hair loss.

Worse, there’s no known method for predicting these horror stories; they strike at will. On Supernatural Acne Treatment, we don’t recommend accutane in any circumstances, because it’s a pure Russian roulette treatment.

That’s why today’s article will cover the classic arguments which you should always ignore, from internet posters to professional dermatologists. 

 

ONE – I’ve tried everything else!

This is the classic one. The most common internet story goes like this. Acne patient X has spent years experimenting with every acne remedy under the sun, including antibacterial creams, doxyclycline and birth control pills. Their bathroom is littered with empty bottles of all shapes and sizes.

Maybe you’ve felt this way yourself – in desperation, sick and tired of every recommended treatment being a mere sticker patch on the problem.

Therefore, accutane is the only option left, the acne-drug of last resort. It might have side effects, it might be the nuclear option, but it’s their only chance left of getting clear skin.

The truth, however, is that not a single new accutane user has exhausted every acne strategy in existence. In fact, a large amount have barely tried 10% of them.

Most accutane adopters are stuck on the rigid rails of traditional dermatology – benzoyl peroxide, followed by topical and then oral antibiotics. At best, they might have tried the classics like toothpaste or ditching milk, but that’s only scratching the surface.

The world of natural acne remedies includes vitamin E, zinc, avoiding sugar, eating more antioxidants (strawberries, pomegranate), minimising grains, dodging FODMAPs – the list goes on. That’s not even mentioning natural topical treatments. Accutane is a synthetic form of vitamin A, yet few first time adopters try an all out vitamin A strategy, combining more in the diet with topical treatments rich in it like sea buckthorn oil.

Which illustrates something else – even when people do know natural remedies, they very rarely combine them.

Instead, they move from one remedy to another in isolation, with no thought out, coordinated strategy. For example, taking magnesium is a great idea. We recommend it constantly here, but it will never clear your acne alone. However, if you combine it with reducing sugar, and eating broccoli daily, you may be in business.

It doesn’t help that dietary strategies are still branded as a myth by big dermatology organisations. People are feeling despair and being led into the arms of accutane for no reason other than incomplete knowledge.

 

TWO – it changed my skin forever!

Similar to the “nothing else ever worked” argument. This is the most tempting argument of all, the happy stories that paint a picture of a bright and shining clear skin future if only you endure accutane for six months.

People rave about how their confidence came roaring back, how they had a social life again, and were no longer a frightened recluse hiding in their bedroom. For undecided people, swaying from one side to the other, this psychological argument regularly gives them the final push.

We’re not insinuating that these people are lying whatsoever; accutane really has changed people’s lives. We’re not even saying that accutane doesn’t work, because its oil drying, skin cell-dissolving powers are immense. What we’re saying is that this happily ever after story can be achieved using much gentler means which don’t randomly trigger IBS.

Accutane has numerous mirror images in the natural realm that can produce truly shocking improvements, all by themselves. Just check out the reviews of zinc on acne.org. In this study, 54.1% of acne patients were found to be deficient versus 10% in normal people. This and this study found 33% and 49.8% reductions in pimple counts respectively. Likewise, green tea lotion reduced inflammatory acne by 48.5% here.

Combining loads of smaller acne strategies will also put the dark pimple past behind you – it just requires more effort. For example, the anti-inflammatory compounds in ginger, and applying honey to a red and angry pimple.

At its root though, this argument is based on psychology and temptation, nothing more. Some people say that accutane “sounds like a dream”, but that’s exactly correct: accutane is too good to be true.

You too can ride off into an acne-free sunset, but you don’t need accutane to do it!

 

Three – it’s a load of overblown nonsense

This argument claims that the fear factor is exaggerated by the horrible internet stories of hair loss and depression. This only happens to 10-20% of users, so when accutane users experience only mild side effects like dry lips, they assume that their original fears were unjustified. They post all over the internet, in a well intentioned effort to reassure other worried people.

But the whole point was never that accutane’s severe side effects happen to everyone. It’s that they happen a small percentage of the time, but strike totally at random.

They’re nearly impossible to predict, particularly depression and gastrointestinal problems. If anything, birth defects is one of the smallest worries, not for severity, but because doctors force you to sign the iPledge. This system forces you to abstain from sex, take birth control, and gives doctors a legal shield in case you somehow get pregnant.

Then there’s a similar argument: that the side effects are real, but fade away quickly. It’s unpleasant, but you just have to stick the dry lips out for 6 months, and clear skin will be yours to behold.

The fact is though, that some people suffer for years afterwards. They have to exfoliate their skin religiously to reduce the dryness or flakiness. Some have increased sensitivity to sunlight for years afterwards, making sunny Hawaiian beach holidays a thing of the past.

It’s a roll of the dice; it’s possible that elevated cholesterol could follow you forever. Then there’s the men who claim that their sex drive was never the same again. Accutane lovers also claim that the massive amount of court cases (7000 personal injury lawsuits as of 2014) has caused undue fear, or that people with bad experiences are more likely to post testimonials. The latter is probably true, but it doesn’t stop the random nature of the dangers.

Common quotations include “don’t be alarmed”, “no need for panic”, or a simple “don’t worry about it mate”. I’ve even heard of dermatologists gently reassuring their patients that accutane is safer than other remedies – but those “other remedies” are only oral antibiotics and other pharmaceuticals!

 

Four – side effects are a nature of drugs

The other side of the coin. This one acknowledges the risk of side effects, but claims that weighing up pros and cons is a natural part of life.

For example, it’s like flying across the Atlantic. A bolt of lightning could always strike the plane, but will it? Probably not. Instead of the enticing, happily ever after of argument 2, this one depends on sounding reasonable.

However, here we come back to the random nature. Accutane is very different to say, paracetemol, whose dangers like a racing heartbeat are known to target people with liver problems, by depleting your glutathione reserves.

The liver rule also applies to accutane, but most of its side effects have no prediction methods whatsoever. The reasonable “weighing up the odds” theory doesn’t work. The internet is full of people who said “best decision I ever made”, who did weigh up the odds and ultimately jump in. But there’s just as many prematurely balding people wishing they’d never heard of accutane, reflecting that ultimately, they should have been more cautious, that a few pimples wasn’t their defining quality in life. It’s one thing to say “let’s be reasonable here folks” when debating on an internet forum, it’s another when a full head of hair is on the line.

This argument would work better if argument one was true, that accutane was really a last resort treatment. Otherwise, your only other option would be to accept your acne and try valiantly not to feel self conscious. Luckily, your opportunities are plentiful.

 

Five – accutane will clear you for good

The saying goes that if you grit your teeth, and endure the dry lips and muscle weakness for 6 months like a hardened warrior, you will emerge from the other side a changed person with no need to look back.

It’s often said that accutane is a one and done treatment, including on official dermatology pages. But is it? Across various studies, the relapse rate ranges from 14.6% to 52%. For example:

ONE: this 2013 study investigated whether accutane was more or less effective in women with PCOS (it was the same), but also found that out of 96 women, 8 relapsed within 1 year followed by another 16 within 2 years. Women with PCOS were more likely to relapse.

TWO: in an epic study stretching across 9 years, 113 male and 75 female were gathered, averaging at 25 years old, young enough to be relevant to most people. The accutane had no set timetable, lasting for as long as it took them to heal. 111 fared well, taking one course and never witnessing pimples again. However, 54 patients took multiple courses of accutane to finally achieve clear skin. 23 failed to get clear skin even after multiple courses.

THREE: this 2006 review examined numerous studies and found that an average of 12% never achieved clear skin using accutane, while 29-39% relapsed. Men, young people and hormonally imbalanced people were particularly prone to relapsing.

For this argument, we don’t need to weigh up the odds; we just need raw scientific data. Plus, the pathway by which accutane cures acne permanently is the same as makes the side effects permanent. It’s down to the vitamin A accumulating in your stores, unlike vitamin C which is rapidly removed from the bloodstream.

Accutane dries your skin out by physically shrinking the oil glands (as well as decreasing their activity) and in other places, this may never rebound when pushed too far.

If you take enough accutane to never relapse, then you’ve probably taken enough to have permanently dry lips.

 

Six – a grieving congressman imagined the depression link

Depression is probably the symptom that has lost its fear factor the most recently. The story goes that in 2000, the previously happy Bart Stupak suddenly committed suicide after returning from his prom date. His father was Rep. Bob Stupak of the House Of Representatives.

After much soul searching, he and his wife could only think of one culprit – the accutane he was prescribed six months earlier. According to social media posters, a grieving Stupak lobbied the FDA so hard that all accutane pills must now display a suicide warning. In 2002, he testified to a congressional committee. The saga concluded in 2009 when a court ruled in favour of Roche, banning Stupak from blaming accutane for his son’s death.

The truth is that all of these events took place, but it wasn’t the main factor. The depression link was well known before 2000. In 1998, FDA told all US doctors that accutane “may cause depression, psychosis, and, rarely, suicidal ideation, suicide attempts and suicide,” and to watch patients for symptoms. Rep. Stupak seized on these theories, but he didn’t make them up. His argument was actually that the FDA had done a poor job of spreading the word.

The studies on depression are mixed, including this 2005 review which found “no clear proof of an association“. This 2018 study warned of crazy mood swings in both directions (depression and mania), while this 2019 study found that accutane improved depression scores.

However, this aligns perfectly with accutane’s random nature. If depression only happened to 20% of people, with 5% truly being in the blackest pits, then studies would inevitably be inconsistent. It doesn’t contradict our stance at all.

One really feeble argument is that the depression was caused by the original acne – but this doesn’t explain why it worsens with accutane. People do break out in the first two weeks, but it’s too inconsistent.

People also claim that accutane cannot cross the brain-blood barrier, but doesn’t mean anything. For example, it’s known to increase the amino acid homocysteine, which itself is strongly linked to depression.

Plus, you only have to read the vast chronicles of the internet. There are too many stories of depression to ignore. The risk isn’t “pseudo science fearmongering“. It’s not just people who swore off accutane forever – even delighted success stories mention the “months of depression”. A lone congressmen is not the sole cause.

 

Seven – it’s a tried and tested tool

This is the argument from a handful of forum posters with blind faith in health authorities.

Instead of not knowing the vast potential of natural strategies (like argument 1), they dismiss them completely because the NHS or American Academy of Dermatology says the same. They say that accutane is firmly under the control of responsible doctors, who will perform a blood test every month to make sure nothing is wrong.

They act like every individual dermatologist is an infallible authority, like they’re robots with an encyclopedia of knowledge programmed into them, and any contradiction to this faith seems to be a personal affront to them. They have no respect for common sense, or even scientific studies (because zinc and dodging dairy have plenty), only for a shiny dermatological badge.

These people then trash others who suggest natural alternatives. The accutane webpages of dermatology bodies also give off this reassuring “tried and tested” feeling.

The fact though, is that dermatologists are wrong all the time, even if they’re well meaning. You only have to look at another mainstay of dermatology – antibiotics.

In the 1980s, clindamcyin and tetracycline ruled the acne world, but by 2000, 64% of p.acnes bacteria was immune to antibiotics (study). In 1979, only 20% was resistant. The great ship of dermatology changes direction at an agonisingly slow rate, but in 2016, British NHS dermatologists finally announced that antibiotics had to be restricted or else. Their golden child had gone down the drain.

Professional dermatology is not the be all and end all. In 100 years, accutane could also be looked on as a historical mistake as well, a brief three decades of madness. They were mistaken once and they can be mistaken again.

As for blood tests, doctors check for elevated liver enzymes, to spot liver damage. However, we barely understand how accutane causes IBS, so a monthly check up won’t do anything.

The proponents of this argument seem to be stuck in a timewarp. They haven’t noticed the last 20 years of research on diet and acne, and still believe that dodging dairy and chocolate is silly schoolyard science from frustrated teenagers.

 

Conclusion

As of 2020, there is still no good reason to walk the risky road of accutane. Every argument can be defeated with common sense and even scientific studies.

An argument from dermatologists is that 35 years have passed since accutane’s introduction in September 1982, and they’ve spent every waking moment perfecting it. The truth? Sure, they have optimised their dosages. They’ve perfected their treatment plan and understand the side effects to watch out for, but they cannot change the nature of the substance itself. There’s only so much they can control. The very process of accutane clearing acne relies on an insanely high dosage of vitamin A far beyond the body’s natural territory.

Just consider the first ever experiment in 1971, by Werner Bollag. He working on a drug for skin cancer, but noticed massive reductions in acne. However, he also discovered its teratogenic, or embryo mutating powers. With the 1950s thalidomide scandal still hanging over drug company’s heads, he flatly refused to consider releasing accutane as an acne drug. The idea of releasing a category X pregnancy disruptor for such a trivial problem as acne was appalling to him.

Thus, when Dr Frank Yoder and Gary Peck discovered accutane’s powers themselves in 1976, Roche never informed them of the original experiment. They only found out in 1986.

Say no to accutane, say yes to exploring the natural realm of acne. 

 

Thanks for reading!